Formulir Pendaftaran Santri Baru Tpa Al[1]

FORMULIR PENDAFTARAN SANTRI BARU TPA AL-MUHAJIRIN TH ........../...........

A. IDENTITAS CALON SANTRI

1.  Nama Lengkap 2. Jenis Kelamin 3. Tempat Tanggal Lahir

:...................................................... ............................................... :..................................................................................................... :..................................................................................................... :...................................................... ............................................... :..................................................................................................... :...................................................... ...............................................

B. IDENTITAS ORANG TUA

1. AYAH  Nama  NIK TTL Pekerjaan

:...................................................... ................................................ :...................................................................................................... :...................................................................................................... :...................................................... ................................................ :...................................................................................................... : a.Wiraswasta d. Petani g.PNS/TNI/POLRI b. Nelayan c. Wirausaha

Pendidikan

 penghasilan 2. IBU  Nama  NIK TTL Pekerjaan

Pendidikan

 penghasilan 3. Alamat Rumah

: a. Tidak Sekolah  b.SD c.SMP/Sederajat : a.500Ribu - 1 Juta  b. 1 Juta  –  2 Juta

e.Peternak f. Buruh

h. Karyawan Swasta i. Pedagang

d.SMA/Sederajat e.D1 f.D2 c.2 Juta - 3Juta d.3 Juta- 4Juta

g. D3 h. S1 i. S2

:...................................................... ............................................... :..................................................................................................... :.................................................................................................... :...................................................... .............................................. :..................................................................................................... : a.Wiraswasta d. Petani g. PNS/TNI/POLRI b. Nelayan e.Peternak h. Karyawan Swasta c. Wirausaha f. Buruh i. Pedagang : a. Tidak Sekolah d.SMA/Sederajat g.D3  b.SD e.D1 h. S1 c.SMP/Sederajat f.D2 i. S2 : a.500Ribu - 1 Juta c.2 Juta - 3Juta  b. 1 Juta  –  2 Juta d. 3 Juta- 4Juta :..................................................................................................... :....................................................... .............................................. ...................................................................................................... ......................................................................................................

4.  Nomer HP

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Mengetahui, OrangTua/Wali Santri